Provider Demographics
NPI:1063221208
Name:NAIR, MALAVIKA SANTHOSH (PA-C)
Entity type:Individual
Prefix:
First Name:MALAVIKA
Middle Name:SANTHOSH
Last Name:NAIR
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:12070 OLD LINE CTR STE 212
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2567
Mailing Address - Country:US
Mailing Address - Phone:301-710-0455
Mailing Address - Fax:
Practice Address - Street 1:1850 TOWN CENTER PKWY STE 310
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3300
Practice Address - Country:US
Practice Address - Phone:703-570-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-08-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant